Hartmann A, Lahoda T, Burger W, Beyersdorf F, Schräder R, Satter P
Department of Interventional Cardiology, St. Georg Medical Center, Leipzig, Germany.
Cardiology. 1997 Sep-Oct;88(5):425-32. doi: 10.1159/000177372.
The endothelium-dependent and endothelium-independent vasodilation of arterial and venous coronary bypass grafts and of epicardial conduit vessels and microcirculatory coronary vessels supplied by these grafts was investigated. Vasodilatory response and flow regulation were tested with cumulative intracoronary doses of acetylcholine (25 and 50 micrograms i.c.), nitroglycerin (0.3 mg i.c.), and papaverine (10 mg i.c.) in 10 patients (age 60 +/- 2.3 years) with arterial grafts and in 16 patients (age 57.7 +/- 1.5 years) with venous grafts. The effect of acetylcholine on arterial and venous bypass grafts and on large conduit arteries was evaluated by quantitative coronary angiography. Coronary blood flow velocity changes as a parameter of microcirculatory function were measured by intraluminal Doppler ultrasound. Indices for coronary flow and coronary resistance were calculated from the mean Doppler flow velocity and the computed cross-sectional vascular area. The coronary resistance decreased endothelium dependent after 25 and 50 micrograms of acetylcholine by 16 +/- 30% (p < 0.05 vs. control) and 22 +/- 25% (p < 0.05 vs. control), respectively, in regions supplied by venous grafts and by 48 +/- 20% (p < 0.05 vs. control and vs. venous graft) and 41 +/- 32% (p < 0.05 vs. control), respectively, in regions supplied by arterial grafts. The coronary resistance decreased endothelium independent after 0.3 mg nitroglycerin and 10 mg papaverine by 18 +/- 56% (p < 0.05 vs. control) and 39 +/- 29% (p < 0.05 vs. control), respectively in regions supplied by venous grafts and by 45 +/- 45% (p < 0.05 vs. control) and 70 +/- 12% (p < 0.05 vs. control and vs. venous graft), respectively in regions supplied by arterial grafts. In conclusion, during the long-term course after coronary artery bypass grafting, vascular regions supplied by arterial grafts have a better preserved endothelium-dependent and endothelium-independent flow reserve as compared with vascular regions supplied by venous grafts.
研究了动脉和静脉冠状动脉旁路移植血管、心外膜管道血管以及由这些移植血管供血的冠状动脉微血管的内皮依赖性和非内皮依赖性血管舒张功能。对10例（年龄60±2.3岁）接受动脉移植的患者和16例（年龄57.7±1.5岁）接受静脉移植的患者，采用冠状动脉内累积注射乙酰胆碱（25和50微克冠状动脉内注射）、硝酸甘油（0.3毫克冠状动脉内注射）和罂粟碱（10毫克冠状动脉内注射）的方法，测试血管舒张反应和血流调节。通过定量冠状动脉造影评估乙酰胆碱对动脉和静脉旁路移植血管以及大管道动脉的影响。采用腔内多普勒超声测量冠状动脉血流速度变化，作为微循环功能的参数。根据平均多普勒血流速度和计算得出的血管横截面积计算冠状动脉血流和冠状动脉阻力指数。在静脉移植血管供血区域，冠状动脉内注射25微克和50微克乙酰胆碱后，冠状动脉阻力内皮依赖性降低，分别为16±30%（与对照组相比，p<0.05）和22±25%（与对照组相比，p<0.05）；在动脉移植血管供血区域，分别为48±20%（与对照组和静脉移植血管供血区域相比，p<0.05）和41±32%（与对照组相比，p<0.05）。在静脉移植血管供血区域，冠状动脉内注射0.3毫克硝酸甘油和10毫克罂粟碱后，冠状动脉阻力非内皮依赖性降低，分别为18±56%（与对照组相比，p<0.05）和39±29%（与对照组相比，p<0.05）；在动脉移植血管供血区域，分别为45±45%（与对照组相比，p<0.05）和70±12%（与对照组和静脉移植血管供血区域相比，p<0.05）。总之,在冠状动脉旁路移植术后的长期病程中，与静脉移植血管供血区域相比，动脉移植血管供血区域的内皮依赖性和非内皮依赖性血流储备保存得更好。
